Provider Demographics
NPI:1871165233
Name:POYANT, FERNANDA (LCSW)
Entity type:Individual
Prefix:
First Name:FERNANDA
Middle Name:
Last Name:POYANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:FERNANDA
Other - Middle Name:
Other - Last Name:CHEPLUKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 TRINIDAD ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-2328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:66 BURNETT ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-2527
Practice Address - Country:US
Practice Address - Phone:401-785-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW025871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty